But they [liberals] can take at least some comfort in looking overseas–where
one tiny country has managed to build a popular and successful
universal health care program based entirely on private insurance. That
country is the Netherlands, which several years ago overhauled its
health care system and achieved most of the goals the liberal reform
movement holds dear: near-universal coverage, affordable insurance, and
quality health care.

Under the new system, the Dutch government has required that
everybody gets insurance; in return, it makes sure insurance is
available to everybody, regardless of pre-existing medical conditions
or income. Although the government finances long-term care through a
public program, it has turned over the job of providing basic medical
coverage exclusively to private insurers, including some for-profit
companies. Surveys show that the Dutch are happier with their health
care than are Americans–or the people of any other developed country,
for that matter. There are even signs, albeit faint ones, that the
insurers are achieving what’s become the Holy Grail of health reform:
using their leverage to improve the quality of care that doctors and
hospitals provide–by improving the coordination of treatments for the
chronically ill or steering patients to providers that get the best
outcomes.

Great, right?

Still, there’s a catch. A big catch. Private insurance in the
Netherlands works because it operates more or less like a public
utility. The Dutch government regulates industry practices
tightly–more tightly than the reforms now moving through Congress
propose to do in the United States. The public insurance option was
supposed to make up for that deficiency, at least in part, by setting a
standard for service and affordability that the private industry would
have to meet–and by offering a fail-safe option in case the private
plans simply couldn’t keep up. If Congress ends up gutting the public
plan, in part or in whole, then it needs to work even harder on making
private insurance work. And it’s an open question whether that will
happen.

Pretty big catch. With the current plans, health insurers are on-board– one of the big reasons that some reasonable version of health care reform most likely will pass. Regulate them as much as they do in the Netherlands, and keeping them on-board becomes a much more dicey proposition. Again, we're back to the issue I raised in an earlier post: public option or regulate the hell out of insurers. Do neither and health reform, though worthwhile, is a lot less successful policy reform than it otherwise could be.